Oxford Outcomes Ltd., West Way, Botley, Oxford, UK.
Clin Drug Investig. 2012 Jan 1;32(1):15-27. doi: 10.2165/11593310-000000000-00000.
BACKGROUND: Multiple sclerosis (MS) is a common, chronic, neurodegenerative condition associated with substantial healthcare and societal economic burden. Disease-modifying MS treatments have the potential to reduce health resource utilization (HRU), thereby reducing the attendant socioeconomic burden. OBJECTIVE: This study aimed to compare health and societal resource use and productivity in patients with relapsing-remitting MS (RRMS) receiving cladribine tablets versus placebo over 96 weeks in the CLARITY study. METHODS: The CLARITY study was a 96-week, randomized, double-blind, placebo-controlled study in patients with RRMS. HRU data, societal resource use and productivity data were collected at baseline and during scheduled patient visits, at 6-month intervals. The recall period for the HRU questionnaire was 3 months. The study was carried out at 155 sites across 32 countries worldwide. The intent-to-treat population comprised 1326 patients with RRMS randomized to cladribine 3.5 mg/kg (n = 433) or 5.25 mg/kg (n = 456) tablets or placebo (n = 437). Patient subgroups with high baseline disease activity were identified based on criteria of ≥2 relapses in the previous year (n = 392); ≥1 T1 gadolinium-enhancing (Gd+) lesion (n = 413); and ≥2 relapses in the previous year plus ≥1 T1 Gd+ lesion (n = 138). Cladribine tablets were administered in two (3.5 mg/kg group) or four (5.25 mg/kg group) short courses given at 4-week intervals at the start of a 48-week treatment period, followed by another two courses at the start of a subsequent 48-week re-treatment period. Interferon-β rescue therapy was permitted from week 24. Intravenous corticosteroids were available for the treatment of neurological relapses. HRU outcomes included mean number of hospital days and emergency room (ER), clinic and home visits during each study period. Societal resource use and productivity outcomes included mean number of hours and days of paid assistance, mean patient and carer work days missed, and self-reported productivity. RESULTS: The mean number of hospital days per patient over 96 weeks was lower in the cladribine tablets groups (3.5 mg/kg group: -3.19 days; 5.25 mg/kg group: -1.54 days [both p < 0.01]) versus placebo. Likewise the mean number of ER visits was lower in both cladribine tablet groups compared with placebo (3.5 mg/kg group: -0.09 visits; 5.25 mg/kg group: -0.11 visits [both p < 0.01]), and the mean number of clinic visits was also lower in both cladribine tablet groups (3.5 mg/kg group: -0.68 visits; 5.25 mg/kg group: -0.66 visits [both p = 0.01]). Furthermore, treatment with cladribine tablets was associated with reduced mean numbers of missed work days for patients (3.5 mg/kg group: -2.42 days [p < 0.01]; 5.25 mg/kg group: -0.60 days [p = 0.50]). Corticosteroid use was lower amongst patients in the cladribine tablet groups than in the placebo group. The reduction in hospital days following treatment with cladribine tablets was also observed in patients with high disease activity at study baseline. CONCLUSION: This study provides evidence that the efficacy of cladribine tablets observed during the CLARITY study was associated with a reduced consumption of healthcare resources and a decreased need for medical and societal support. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00213135; EudraCT number: 2004-005148-28.
背景:多发性硬化症(MS)是一种常见的、慢性的、神经退行性疾病,与大量的医疗保健和社会经济负担相关。疾病修正治疗 MS 的方法有可能减少卫生资源的利用(HRU),从而减轻随之而来的社会经济负担。
目的:本研究旨在比较 CLARITY 研究中接受克拉屈滨片与安慰剂治疗的复发性缓解型 MS(RRMS)患者在 96 周内的健康和社会资源使用以及生产力情况。
方法:CLARITY 研究是一项为期 96 周、随机、双盲、安慰剂对照的 RRMS 患者研究。HRU 数据、社会资源使用和生产力数据在基线和预定的患者访视时收集,每 6 个月一次。HRU 问卷的回忆期为 3 个月。该研究在全球 32 个国家的 155 个地点进行。意向治疗人群包括 1326 名 RRMS 患者,随机分为克拉屈滨 3.5mg/kg(n=433)或 5.25mg/kg(n=456)片或安慰剂(n=437)。根据前一年≥2 次复发(n=392)、≥1 个 T1 钆增强(Gd+)病变(n=413)和前一年≥2 次复发+≥1 个 T1 Gd+病变(n=138)的标准确定具有高基线疾病活动的患者亚组。克拉屈滨片在开始为期 48 周的治疗期时给予两次(3.5mg/kg 组)或四次(5.25mg/kg 组)短疗程,每 4 周一次,然后在随后的 48 周再治疗期开始时再给予两次疗程。从第 24 周开始允许使用干扰素-β解救治疗。静脉内皮质类固醇可用于治疗神经复发。HRU 结果包括每个研究期间的平均住院天数和急诊室(ER)、诊所和家庭就诊次数。社会资源使用和生产力结果包括平均需要的付费帮助小时数和天数、平均患者和照顾者缺勤天数以及自我报告的生产力。
结果:96 周期间,克拉屈滨片组(3.5mg/kg 组:-3.19 天;5.25mg/kg 组:-1.54 天[均 p<0.01])的每位患者的平均住院天数低于安慰剂组。同样,与安慰剂相比,克拉屈滨片组的急诊室就诊次数也较少(3.5mg/kg 组:-0.09 次;5.25mg/kg 组:-0.11 次[均 p<0.01]),并且克拉屈滨片组的诊所就诊次数也较低(3.5mg/kg 组:-0.68 次;5.25mg/kg 组:-0.66 次[均 p=0.01])。此外,与安慰剂相比,克拉屈滨片治疗与患者的平均缺勤天数减少相关(3.5mg/kg 组:-2.42 天[p<0.01];5.25mg/kg 组:-0.60 天[p=0.50])。与安慰剂组相比,克拉屈滨片组的患者使用皮质类固醇的情况较少。在基线疾病活动较高的患者中,也观察到克拉屈滨片治疗后住院天数减少。
结论:本研究表明,CLARITY 研究中观察到的克拉屈滨片的疗效与减少卫生保健资源的消耗和减少对医疗和社会支持的需求有关。
临床试验注册:ClinicalTrials.gov 标识符:NCT00213135;EudraCT 编号:2004-005148-28。
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